0102-214 (RPL)LICENSED CONTRACTOR DECLARATION
t9hQby affirm under penalty of perjury that I am licensed under provisions of
Chap er 9 (commencing with Section 7000) of Division 3 of the'Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
1.a4 C-514 i I'll I/V
Date "' ti+ Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
(. ) A have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
.( ) I have and will maintain workers' compensation insurance, as required by
SeAon 3700 of the Labor Code, for the performance of the work for which this
p1rmit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions:R
bate .:jam, 1-,'y;V1 1 Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawfuftand
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT, Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his%
application. Of
1. Each person upon whose behalf this application is made & each peson'at
'whose request M.td for whose'benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, Indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance; of such
permit;Forcessation of,work for,180 days will subject permit to cancellation.
I certify that I have read this application and state -that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. `
Signature (Owner/Agent)
BUILDING PERMIT PERMIT#
TRACT
DATE �� (� VALUATION LOT TRACT
`ted
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JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
7 20 JAM NICKLAUD
71960 ERGHWAY I I
T.A QUNTiA. CA, 92M
PALM 'T E811. -Mf CA 92255-1f,
(760)340.2588 045.4 1104
USE OF PERMIT
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MECHANICAL FFIZ -- P00101. 101.600421441 $200
R=XiT R1CAL PFA "- P00L; 101440-4-20-000 $135.06
P'1.1mb;3-m(' n. ..Pool, 101-000-419.000 WIN
FEB 2 $ 2001
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RECEIPT
DATEYy % !! d
BY
DATE FINALED
INSPECTOR ;
�y INSPECTION RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O. -
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Set Backs
Steel
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Final
Underground Pibg. Test
Gas Piping
_
3
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
Encapsulation
_
Gas Test
Appliances
Final
COMMENTS:
7 -1 -
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I. '
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
?7/H/29031 09:19 6749438
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FROM : MONARCH -ACCOUNTING
PHONE NO. : 760 776 5112 Feb. 27 2001 04:55 -PM P1
PGA WEST 11 RESIDENTIAL ASSOCIATION, INC.
F.U. BOX. 1282, I-4 QUINTA, CA 922534
(760) 776.5100 FAX (760) 776-5111 -
February 27, 2001
Lorine & Robert Bushman
56-720 lack Nicklaus
La Quinta, CA 92253
Reference: ' 56-720 Jack Nicklaus, La Quinta, CA
Architectural Change Request - Spa and Patio Decking
.,ear Mr. 8&Mrs. Bushman:
.Che Architectural Committee and the Landscape Committee have reviewed your plans for the addition of
a spa, patio decidng and additional landscaping at their meetings on February 20th and February 22nd
respectively. Your resubmitted plans adding the property dimensions were unanimously approved.
f'
Review. by the Committee is only for general conformance with the architectural guidelines. It is the
-responsibil ty of the owner to fully understand and conform to the architectural guidelines criteria
whether or not all deficiencies are noted during review. It is also the owner's full responsibility to field
verify all existing conditions. The Committee's decision with regard to project design will be final. Please
refer to the PUD Architectural Guidelines and Application for Change for all required submittals.
A one-year, warranty will be required for new trees planted and a 90 -day warranty for new shrubs
planted. Please contact Raphael Villareal, supervisor for Valley Gardening Service at 760/399-1844 and
Carol Fuller, the Association Manager, prior to any irrigation modifications associated with this change.
Upon completion of changes, please contact Carol Fuller. Damage to the landscaping, i.e., shrubs, trees,
flowers and turf is the responsibility of the contractor. The landscaping must be brought back to its
^riginai condition when the project is completed.
Approvals given by the Architectural Committee are good for only six months from the date on the
approval leiter. After that time a new application must be submitted.
Alt you have any additional questions or concerns, please do not hesitate to contact Carol Fuller,
.rssociation Manager, at 760/776-5100, Ext. 20.
.:incerely,
'GA WEST II RESIDENTIAL ASSOCIATION
.-.or the Architectural Committee
.or the Landscape Committee
Varol Fullers
ssociation Manager
Boud of Directors
Uni= File
i.